DuBois Steven G, Krailo Mark D, Gebhardt Mark C, Donaldson Sarah S, Marcus Karen J, Dormans John, Shamberger Robert C, Sailer Scott, Nicholas Richard W, Healey John H, Tarbell Nancy J, Randall R Lor, Devidas Meenakshi, Meyer James S, Granowetter Linda, Womer Richard B, Bernstein Mark, Marina Neyssa, Grier Holcombe E
Department of Pediatrics, University of California-San Francisco (UCSF) School of Medicine and UCSF Benioff Children's Hospital, San Francisco, California.
Cancer. 2015 Feb 1;121(3):467-75. doi: 10.1002/cncr.29065. Epub 2014 Sep 23.
Patients with Ewing sarcoma require local primary tumor control with surgery, radiation, or both. The optimal choice of local control for overall and local disease control remains unclear.
Patients with localized Ewing sarcoma of bone who were treated on 3 consecutive protocols with standard-dose, 5-drug chemotherapy every 3 weeks were included (n=465). Propensity scores were used to control for differences between local control groups by constructing multivariate models to assess the impact of local control type on clinical endpoints (event-free survival [EFS], overall survival, local failure, and distant failure) independent of differences in their propensity to receive each local control type.
Patients who underwent surgery were younger (P=.02) and had more appendicular tumors (P<.001). Compared with surgery, radiation had higher unadjusted risks of any event (hazard ratio [HR], 1.70; 95% confidence interval [CI], 1.18-2.44), death (HR, 1.84; 95% CI, 1.18-2.85), and local failure (HR, 2.57; 95% CI, 1.37-4.83). On multivariate analysis, compared with surgery, radiation had a higher risk of local failure (HR, 2.41; 95% CI, 1.24-4.68), although there were no significant differences in EFS (HR, 1.42; 95% CI, 0.94-2.14), overall survival (HR, 1.37; 95% CI, 0.83-2.26), or distant failure (HR, 1.13; 95% CI, 0.70-1.84) between local control groups.
In this large group of similarly treated patients, choice of the mode of local control was not related significantly to EFS, overall survival, or distant failure, although the risk of local failure was greater for radiation compared with surgery. These data support surgical resection when appropriate, whereas radiotherapy remains a reasonable alternative in selected patients.
尤因肉瘤患者需要通过手术、放疗或两者结合来实现局部原发肿瘤的控制。对于整体和局部疾病控制而言，局部控制的最佳选择仍不明确。
纳入连续3个方案采用每3周标准剂量5药化疗治疗的局限性骨尤因肉瘤患者（n = 465）。通过构建多变量模型来控制局部控制组之间的差异，以评估局部控制类型对临床终点（无事件生存期[EFS]、总生存期、局部失败和远处失败）的影响，该模型独立于接受每种局部控制类型的倾向差异。
接受手术的患者更年轻（P = 0.02），且四肢肿瘤更多（P < 0.001）。与手术相比，放疗在任何事件（风险比[HR]，1.70；95%置信区间[CI]，1.18 - 2.44）、死亡（HR，1.84；95% CI，1.18 - 2.85）和局部失败（HR，2.57；95% CI，1.37 - 4.83）方面有更高的未调整风险。多变量分析显示，与手术相比，放疗有更高的局部失败风险（HR，2.41；95% CI，1.24 - 4.68），尽管局部控制组之间在EFS（HR，l.42；95% CI，0.94 - 2.14）、总生存期（HR，1.37；95% CI，0.83 - 2.26）或远处失败（HR，1.13；95% CI，0.70 - 1.84）方面无显著差异。
在这一大组接受相似治疗的患者中，局部控制方式的选择与EFS、总生存期或远处失败无显著相关性，尽管放疗的局部失败风险高于手术。这些数据支持在合适时进行手术切除，而放疗在特定患者中仍是合理的替代选择。
